Basic Information
Provider Information
NPI: 1225500127
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LADOW
FirstName: ERIC
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5400 FRANTZ RD STE 250
Address2:  
City: DUBLIN
State: OH
PostalCode: 430166102
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 285 E STATE ST STE 400
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432154368
CountryCode: US
TelephoneNumber: 6145667370
FaxNumber: 6145330187
Other Information
ProviderEnumerationDate: 12/18/2018
LastUpdateDate: 01/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X50.005817RXOHY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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